smoking cessation, cardiac rehabilitation, secondary prevention



  1. Tzou, Wendy MD
  2. Vitcenda, Mark MS
  3. McBride, Patrick MD, MPH


PURPOSE: Smoking cessation is a priority for patients with cardiovascular disease (CVD). Smoking correlates and predictors were studied after CVD events in outpatient cardiac rehabilitation (OCR) with the aim of characterizing CVD patients at high risk for continued smoking.


METHODS: Subjects hospitalized during 1996-2002 for CVD events were referred to OCR. Smoking prevalence was compared among OCR and non-OCR patients. Age, sex, body mass index, and working status (independent variables) were analyzed univariately among OCR and non-OCR smoking groups. Lipoproteins, CVD events, and health self-confidence (independent variables) were compared among OCR smoking groups. Multivariate analysis of OCR smoking groups was performed to elicit potential smoking predictors.


RESULTS: Among the 472 OCR and 152 non-OCR patients, non-OCR status (30.5% vs 13.6%, P < .0002) and age younger than 55 years (P < .0002) correlated with current smoking. Male sex (19.4% vs 13%; P = .06) approached significant risk. For OCR patients, younger age (odds ratio [OR], 0.95; P = .003) and angina (OR, 13.7; P = .03), most strongly predicted current smoking. Among all the patients, more current smokers (37%) than former smokers (16.5%) returned to work (P = .0004). More current smokers (6.5%) were disabled than former smokers (1.4%) and never smokers (2.4%) (P < .0002). In the OCR group, the never smokers mean body mass index was the lowest (27.8 vs 29.1 for former smokers and 30.1 for current smokers (P <=.006). Current smokers had the highest triglycerides and perceived that cardiac health did not significantly improve with OCR.


CONCLUSIONS: Smoking with CVD was higher among non-OCR patients, those younger than 55 years, and those with angina. Current smoking status correlated with high triglycerides, poor health self-confidence, and more disability. Outpatient cardiac rehabilitation programs can identify patients at high risk for continued smoking on the basis of these characteristics and should consider new strategies to encourage their participation in smoking cessation and rehabilitation.